Chronic Stroke

Improving hand motor functions in patients with chronic stroke:

Modulation of somatosensory input into non-affected hemisphere

Dissertation der Fakultät für Informations- und Kognitionswissenschaften der Eberhard-Karls-Universität Tübingen zur Erlangung des Grades eines Doktors der Naturwissenschaften (Dr. rer. nat.)

vorgelegt von Dipl.-Psych. Ulrike Nagorsen aus Berlin

Tübingen 2005

Tag der mündlichen Qualifikation: 15.02.2006 Dekan: Prof. Dr. Michael Diehl 1. Berichterstatter: Prof. Dr. Martin Hautzinger 2. Berichterstatter: Prof. Dr. Niels Birbaumer List of contents

List of contents

I Introduction

I.1

I.1.1

Stroke 6

Incidence, risk factor, classification 6

I.1.2 Current therapeutic concepts 8

I.1.2.1 Treatment acute phase 9

I.1.2.2 Treatment subacute and chronic phase 9

I.1.2.3 Treatment of motor deficits 10

I.2 Mechanisms underlying recovery 13

I.2.1 Evidence from animal experiments 14

I.2.2 Evidence from human experimental studies 15

I.3 Brain areas mediating recovery in stroke 17

I.3.1 Relevance of non-affected hemisphere 17

I.3.2 Relevance of affected hemisphere 19

I.3.3 Synopsis 20

I.3.4 Role of interhemispheric interaction- 23

“Concept of hemispheric rivalry”

I.4 Motor tasks 25

1.4.1 Motor performance (experiment I) Finger Tapping task 25

(FT)

I.4.2 Motor performance

References: Classification The most common differentiation divides stroke into two main types: ischemic and hemorrhagic stroke (Elkind, 2003) In the present experiments it is focused on reorganization in the hand motor performance because motor function of the arms and hands can be used to model recovery processes after stroke (Rossini et al., 2003). 1992). (ischemic or hemorrhagic). Early pharmaceutical secondary prophylaxis of ischemic stroke includes treatment with heparin (International Stroke Trial IST, 1997) and thrombocyte aggregation inhibitors, such as ASS (Hass et al., Introduction 10